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The next Flu Drop-in Clinic is at Aberfoyle Medical Centre:

Wednesday 25 October 2:30 to 5:30pm. Note the road closure from the Rob Roy roundabout to the surgery until 3:30pm.

Buchlyvie Medical Centre

Tuesday 17 October 2 to 5 pm.











The Future of rural health in West Stirlingshire




Isobel Madden – Chairman – Friends of Aberfoyle & Buchlyvie Medical Centres -


Jane Grant = Chief Executive of Forth Valley Health Board

Tracey Gillies – Medical Director of Forth Valley Health Board

Fiona Ramsay – Director of Finance – Forth Valley Health Board

Dr Scott Williams - GP Representative


Isobel Madden welcomed the speakers.



Jane Grant started by talking about the health service’s 20/20 vision, looking at providing local care and keeping people in their local communities. She explained that the Health Board understood that one size does not fit all.   The health board needs to be certain how it is going forward in different parts of the community.

In addition there has been a new body formed called the “Integrated Joint Body”. This is a combination of the local authority and health board working together towards a different integrated service for the local community. There will also be a strategic plan drafted to drive a different sort of health and social care.


“The environment in which we are working is complicated but the principles to provide local services for people in an environment in which they are comfortable rather than centralising the vision is what we are trying to do. There is always going to be certain challenges around that.”


Jane Grant then handed over to Tracey Gillies to go through the challenges. It is a big subject so locally it was divided it into 8 work streams.

Tracey Gillies introduced herself as the medical director and stated she had only been in the post 6 months and that this work had just started when she came.  She had just spent the day with medical directors from all over Scotland looking at the challenges

She started by explaining some of the challenges that are facing us in different areas.

One of the challenges is that people are living longer lives.


“ People over the age of 45 will probably have at least one long-term condition and this impact on our health needs. We are looking at how things can be done differently rather than doing more of the same.   What we would like is to be able to do this across Scotland and not just Forth Valley.   This would to allow people to have easy access to the most specialised care for the times when they need it and for more general care to be able to be accessed as close to home as is possible. We would also like that concept to happen around drugs.   Some of you might be aware that there are many very advanced drugs being developed now.


The aim for every Health Board is meeting changing health care needs. How do we actually manage that tension between highly specialised care for a small number of people for complex conditions and then care at a more general level as close to home as possible?”


The Health Board is trying to put together a forward plan which is ambitious enough to make sure that we give people the opportunity to access the best of health care available. So what we have done is we have thought about the pressures that are in the system at the moment and coming our way. We have looked at the evidence around the population and how the population will change and what we can see for the needs of the population. That is what I meant about rising numbers of longterm conditions. What we don’t think people will want if they have three or four longterm conditions is seeing 3 or 4 different people unless that really is adding extra value for them. So how can we bring the management of some of those longterm conditions together so that we give people access to the right amount of expertise but not in such a way that they are spending their whole life going between different appointments and the whole thing doesn’t feel joined up? There is also a real shift in the balance of power within the NHS.


So the goal is to have information is more freely shared, so that people have the information that they need and can make the decisions on what they want about their health. I personally think that is really important.   We have 8 different work streams at the moment looking at the changes that we can see coming. We are examing the literature and looking to every health care system. We are seeing who does this really well and who has a system that could be right for us.


Forth Valley Health Board has split this work into 8 different work streams. These include:

Unscheduled care

Planned care

Infrastructure – buildings and IT


Woman’s and child health



What we plan to do is take the things that the work streams have identified and then start to weave them back together to make a coherent plan. Breaking down into 8 work streams is an artificial means to try to cover the ground and then bring it back together so that we can set out a plan as to how we want to deliver ambitious health care to people in NHS Forth Valley over the next five years.

We want to be in a position where we are able to make the most benefit for those for the population that we look after but not get hung up on the fancy new things.   What is just as important are the relationships people have with the community and how we look after whole families and the carers who provide care in those communities


I am sure people will have questions.




Q – Since the change in legislation in June 2014 – It has been the duty of the Health Board to dedicate areas as controlled localities eg an area like Buchlyvie. How far down the road are the Health Board in designating these controlled localities.


A – The process that you have outlined is a new one.   We have two remaining dispensing practices and obviously we have to look at them. We haven’t dedicated any areas as controlled localities.   We have still to do that.



Q In 2007 the PPC met and decided that a pharmacy was not sustainable or viable in Aberfoyle. There has been one major change in the area – the population has decreased.

If it was not viable or sustainable in 2007 how can it be viable now?


In the training manual for the lay committee members it states that even if Pharmaceutical services are inadequate the issue of sustainability and viability has to take precedence over the necessity for a pharmacy.

The national appeal panel has no power to overturn a decision.   It is only there to make sure that due process has been followed.

The Health Board appointed 3 professional advisors to assist the the lay members in reaching their decision. They organised appropriate training. Despite this support and advice the lay people chose to ignore this guidance. Looking at the minutes there was no record as to how the decision was reached.   I can’t understand why the Health Board rubber stamped this decision and didn’t go back to the committee to ask for further explanation.


Our practice area covers a very wide area. We did ask if outlying areas could be considered as communities with serious difficulty.  In accordance with regulations 3 criteria the Health Board can consider are:

  1. Distance
  2. Communication
  3. Other exceptional circumstances


We were told we could look at this as a community issue then we were told we had to look at specific patients.

We went through our patient list and we identified 41 patients who fulfilled the criteria.

We received a letter from Tracey on 12th December informing us of the outcome of a meeting convened by a subcommittee of GPs from Forth Valley. They met to consider the 41 patients we had presented. We had volunteered to meet with the committee but this offer was rejected.


We learnt that in the opinion of the committee none of these patients presented serious difficulty.

There was no information as to which GPs had been on the committee or where they were from. It seemed from the feedback that we did receive that the issues had not been properly understood.

I quote from one GP comment:

“It can be as hard to travel 2 miles to a pharmacy as 20 miles. Patient in outlying communities would not agreed with this.


We asked 3 times if we could have copies of the minutes of this meeting.

To date we have received no response..

Under Freedom of Information we have learnt that there was no actual meeting. The doctors involved participated and communicated by email.

I find it gob smacking that health care for some of the most vulnerable, remote patients in Forth Valley was decided in this way.

There was no proper meeting at all.


A – I was one of the GPs involved in this project. It was raised at the GP subcommittee and volunteers were asked to give a perspective from a GP point of view with advice from the Central Legal Office. This was fed back to the chairman of the group. To get representation from all over Forth Valley – meeting for every individual subject would be impossible. We all have our practices. So it was done virtually be email and telephone.


Q – Who made the decision?


A – Medical Director replied that she was very clear about what happened.

“The GP subcommittee gave their opinion about the individual cases that Anne and Shionagh supplied and the information about the particular difficulties that patients have –we took professional advice and the profession advice part came from the GP subcommittee and that went to The Performance and Resources a sub committee of the Health Board.”


The Finance Director then spoke. “I would like to go back to the point that Anne made regarding the professional advice. I asked the same question that professional advice had been given and what could the board do. The Health Board went to the central legal office and were advised that the decision of the PPC is deemed to be the decision of the board. The board could not overturn it. The board would be subject to appeal if the board overturned the decision.”


Q –A patient asked “ Can you give us back our dispensary for one calendar year to run side by side with the other pharmacy?”


Q – What happens if Strathard Pharmacy fails? Can the dispensary be reinstated automatically?


A – We would have to re-evaluate the position.


Q – Alex Neil was asked a question in Parliament.   Ifa pharmacy opens in a village with a rural dispensing practice does the practice necessarily have to lose its dispensing licence? The answer he gave was that the Health Board has the powers to allow that practice to retain some or all of its dispensing.


A. We will go and away and look at that one.


Tracey Gillies   - I am just want to say that I am a very honest person I will do my best, I will be on the phone to Anne tomorrow morning and I would be interested at looking at any ideas . We must be positive in some of this and that we can work together and that would be my commitment to all of you.


Isobel Madden thanked the speakers for their input and this part of the meeting was drawn to a close.



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